Pros and cons of sub-specialisation in orthopaedics and traumatology-Is the general orthopaedic and trauma surgeon a relic of the past?

Abstract

The evolution of orthopaedics has witnessed a pronounced shift from generalist practice to subspecialisation, a trend that has fundamentally reshaped the field over the past century. Originally, orthopaedic surgeons were trained to address a broad spectrum of musculoskeletal conditions. However, increasing complexity and specialization in knowledge have driven a progressive narrowing of focus within orthopaedics. This editorial explores the rise of subspecialty training and fellowship programs in orthopaedics, particularly in North America, where over 90% of orthopaedic surgeons now pursue subspecialty fellowships. While subspecialisation has improved surgical outcomes and created experts in specific anatomical regions and techniques, it has also led to challenges. Surgeons with highly focused expertise may face difficulties in managing conditions outside their niche, and subspecialisation may inadvertently limit comprehensive patient care, especially for those with complex, multi-faceted needs. The career paths of orthopaedic trainees are increasingly shaped by both personal interests and market demands, with subspecialists seeking greater professional and economic benefits. Additionally, orthopaedic training models in Europe vary, further complicating a unified approach to subspecialisation. This editorial calls for a balanced perspective that values both subspecialty excellence and the broad-based skills of orthopaedic generalists, particularly as the future of generalist orthopaedic practice faces uncertainty amidst ongoing subspecialisation trends.